Organization
CEDAR COURT IMAGING LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS L. FULK MD (PRESIDENT)
(618) 529-8500
Entity
Organization
Contact information
Practice address
1200 CEDAR CT, CARBONDALE, IL 62901-5334
(618) 529-8500
(618) 549-1000
Mailing address
1200 CEDAR COURT, CARBONDALE, IL 62901-5334
(618) 529-8500
(618) 549-1000
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036091745
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036091745
—
IL
Enumeration date
12/22/2005
Last updated
10/21/2011
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